Why does the Additional Roles Reimbursement Scheme give GP employers funding to take on pharmacists, rather than employers in community pharmacy, asks Nick Kaye…

We are living in a time of unprecedented pressure across all parts of the NHS, and community pharmacy is being asked to step up more and more.

We have a walk-in consultation service in Cornwall, a cancer referral pilot and national services such as the new medicines and discharge medicines services. All this is fantastic as it shows community pharmacy is a place where the public are happy to receive a clinical service.

It also shows that the system is finally recognising that pharmacists have the skillset to deliver such services, and I believe more will come our way if we show we can deliver them well. However, there is no doubt that the two major barriers to overcome if this is to happen are funding and staffing.

On funding, each of these new services should be self-sustaining. It’s not fair to subsidise one activity with another. On a fundamental level, this should also include a margin that allows investment in people and places.

But the reality is that pharmacists and pharmacy technicians are leaving for roles in other parts of the system such as GP practices, and that has meant we are struggling to deliver these new services. We must acknowledge that there is a movement of team members to other parts of the system. I was one of them: I had a portfolio role across general practice and community pharmacy.

It’s important to understand what attracts people to these roles. Is it a chance to work in a multidisciplinary team? Maybe it’s the chance for more flexible working. Indeed, in some cases, it is the chance to use skills such as independent prescribing more freely. But what I found was that I missed the buzz of a community pharmacy, the freedom to interact with team members and the access members of the public had to me.

There is no reception team to hide behind in a community pharmacy and that is why I left general practice in mid-2022. I wanted to go back to being on the frontline in a pharmacy. The part of GP land I miss is interacting with other professionals such as paramedics, GPs and nurses, but I also enjoy being a pharmacist who has that professional interaction with patients.

I find it really valuable and sometimes I can even pop out of the pharmacy for things like school sports day. That was something of a novelty which I missed.

All this has got me thinking about how GP practices are able to create their multidisciplinary team. We know that most of the roles are funded through the Additional Roles Reimbursement Scheme or ARRS funding via the primary care network.

We also know that in most areas this scheme is underspent, so why does the ARRS give GP employers greater funding to take on graduates than employers in community pharmacy?

An ARRS-funded pharmacist?

Increasingly, we are told that community pharmacy is part of the NHS primary care family, so let’s be treated as such. I would love to have an ARRS-funded pharmacist. I bet most of you would agree that if I gave you another pharmacist for free, for 37 hours a week, it would make a massive difference to patient care and your work-life balance and fundamentally reduce the pressure we are all under every day.

Wouldn’t it be great to have another pharmacist: one could provide a consultation-based service in the morning and the other run the dispensary, and then swap over for the afternoon. I bet the number of NMS, DMS and, in Cornwall, walk-in consultations, would go up and add value to our patient services and relieve pressure within the wider NHS. What if one of the pharmacists was an independent prescriber? Could you have a mentor in your pharmacy to help train up those who aren’t yet IPs?

This would increase the number of issues a pharmacy could deal with and close off consultations without referring them to other parts of the system. And what about being able to have a lunch break! It’s such a simple solution and why stop at pharmacists? Why not pharmacy technicians, nurses or paramedics? Let’s have pharmacy technicians doing accuracy checks and helping deliver the discharge medicine service.

When I worked in general practice, the amazing paramedics I worked with could deal with so many issues but their skillset seemed to complement mine as a pharmacist really well. Most patients came to us each day with physical health problems which we were able to deal with, but we still needed to invest in our premises.

In community pharmacy, if we were to get ARRS funding to help to deliver services, I’m sure most of us would invest in the future. So come on, NHS England, let’s have ARRS roles in community pharmacy and we will really show you what we can do!

Nick Kaye is a community pharmacist based in Newquay and vice-chair of the National Pharmacy Association. These are his personal views.